Fitness to drive in spite (because) of THC

Attention-deficit/hyperactivity disorder (ADHD) is characterized by a lack of concentration and/or an altered activation level. People with ADHD are found to violate traffic regulations, to commit criminal offences and to be involved in traffic accidents more often than the statistical norm. Furthermore, they show more deviant behaviour and have an increased co-morbidity regarding substance abuse and dependence. Hence, this disorder is of some forensic importance. The purpose of this case study is to demonstrate that in some cases people with ADHD may show unusual effects after the consumption of THC. A 28-year-old male, who showed abnormal behaviour and seemed to be significantly maladjusted and inattentive while sober, appeared to be completely normal with a very high plasma level of THC. Performance tests conducted with the test batteries ART2020 and TAP provided average and partly above-average results in functions related to driving. Thus, it has to be taken into account that in persons with ADHD THC may have atypical and even performance-enhancing effects.     

Does a positive finding of tetrahydrocannabinol in the blood result from ingestion of Indian frankincense (Boswellia serrata)?

The exculpatory statement that a positive THC finding in the blood is due to the consumption of hemp products or passive exposure to cannabis smoke has been disproved by the monitoring of hemp products and recent passive inhalation studies conducted in social settings, which showed that these conditions are unlikely to produce a positive result in the blood. The defense that the ingestion of Indian olibanum may result in a positive THC concentration in the blood is unusual; it is based on older publications where authors had speculated on a possible association of the synthetic pathways of THC from terpenoid precursors also being present in olibanum and the biogenesis of THC in hemp. It had further been speculated whether chemical or plant-derived pathways may also occur in humans. A thorough understanding of the different pathways and recently published results have outdated these speculations.     

A bouncy house? UK select committee newsworthiness, 2005–18

ABSTRACT

Traditionally, legislative committees have been regarded as quite unimportant in the UK. Some scholars contend that recent reforms have substantially increased the powers of select committees, rendering them genuinely important to policy and the scrutiny of government; others see little sign of change. We examine House of Commons select committees in regard to exactly one indicator of significance, their newspaper coverage. We detect significant gains in salience of some committees, as compared to the period just before the Wright reforms (2005–10). But committees vary dramatically in coverage levels and trends, and it is unclear if their newspaper profiles continue to grow.     

Mediación y jurisdicción voluntaria en el marco de la modernización de la justicia. una aproximación a la legislación española

The legal maxim Justice delayed is justice denied, but is now a reality. People demanding agility and require a solution promptly and fairly close to its interests, it is fitting that in a world dominated by technology, legal and administrative bureaucracy around the delivery of justice to maintain a slow pace. At the international level seek ways of economic and prompt settlement of disputes in this way are promoted among various legal means, first voluntary jurisdiction otherwise the mediation, it is both streamline procedures, however the legal for each is different. The analysis of the article focuses on the legal experience and valuing Spanish first draft Voluntary Jurisdiction Act and the Act on civil and family mediation to establish its various functions in search of an agile and real justice.     

Detection of cocaine in blood stains]

Cocaine is rapidly degraded in blood samples, and its degradation was found to be highly dynamic in nature. The analysis of blood spots dried on filter paper may provide a method to minimize the break-down of cocaine and to largely preserve the analytical profile of the parent drug and its hydrolysis products at the time of sampling. The short term stability of cocaine in 100 microL blood spots prepared from unpreserved and preserved (sodium fluoride, 0.25%) blood samples was compared to the stability of the particular whole blood specimens stored in tubes at ambient temperature and at -20 degrees C. Due to dehydration, both the chemical and the enzymatic hydrolysis of cocaine and its products could be stopped in dried blood spots. More than 75% of the initial cocaine concentration could be detected in the blood spots, and the analytical profile was ensured for 17 days. Provided its practical suitability, the spot technology should offer a simple approach to detect actual impairment of motorists taken in police custody in the view of section 24a of the German traffic act as well as in cocaine associated criminal cases.     

Serum beta-glucuronidase activity in polytrauma patients and in centrifuged autopsy blood samples]

The serum activity of beta-glucuronidase was investigated in 58 patients after severe trauma as well as in 43 autopsy cases. In 10 cases the enzyme activities in postmortem blood samples from the femoral vein were compared to those present in the correspondent heart blood samples. An elevated activity of beta-glucuronidase was observed in 14% of the patients within the first 36 h after severe trauma increasing to 62% in blood samples collected later on. The activity of beta-glucuronidase in the heart blood samples was always higher than in the corresponding sample from the femoral vein. In cases of prolonged post-mortem interval an elevated activity might have been due to bacterial contamination. In postmortal blood samples from the femoral vein an elevated enzyme activity was found in 70% of the study material. The results of the preliminary study on the activity of beta-glucuronidase in blood samples frequent in forensic routine work indicated that an elevated enzyme activity might be present for the following scenery: after severe trauma, in alcohol/drug abuse, presence of putridity/autolysis, presence of inflammatory processes, in diabetes as well as in carcinoma diseases. The significance of elevated beta-glucuronidase activity concerning alterations of unconjugated drug concentration due to in vitro cleavage of O-glucuronides should be investigated.     

Preanalytic aspects in postmortem toxicology

The preanalytic phase has been recognized to have a substantial role for the quality and reliability of analytical results, which very much depend on the type and quality of specimens provided. There are several unique challenges to select and collect specimens for postmortem toxicology investigation. Postmortem specimens may be numerous, and sample quality may be quite variable. An overview is given on specimens routinely collected as well as on alternative specimens that may provide additional information on the route of administration, a long term or a recent use/exposure to a drug or poison. Autolytic and putrefactive changes limit the selection and utility of specimens. Some data from case reports as well as experimental investigations on drug degradation and/or formation during putrefaction are discussed. Diffusion processes as well as postmortem degradation or formation may influence ethanol concentration in autopsy specimens. Formalin fixation of specimens or embalmment of the corpse may cause considerable changes of initial drug levels. These changes are due to alterations of the biological matrix as well as to dilution of a sample, release or degradation of the drug or poison. Most important seems a conversion of desmethyl metabolites to the parent drug. Some general requirements for postmortem sampling are given based on references about specimen collection issues, for a harmonized protocol for sampling in suspected poisonings or drug-related deaths does not exist. The advantages and disadvantages of specimen preservation are shortly discussed. Storage stability is another important issue to be considered. Instability can either derive from physical, chemical or metabolic processes. The knowledge on degradation mechanisms may enable the forensic toxicologist to target the right substance, which may be a major break down product in the investigation of highly labile compounds. Although it is impossible to eliminate all interfering factors or influences occurring during the preanalytic phase, their consideration should facilitate the assessment of sample quality and the analytical result obtained from that sample.     

Fulminant liver failure in a patient on carbamazepine and levetiracetam treatment associated with status epilepticus

A 22-year-old female with a history of developmental delay and seizures successfully treated with carbamazepine and levetiracetam developed fulminant hepatic failure and subsequently died. She had been admitted to the hospital following secondary generalized seizures of 35 min duration. A circulatory shock as well as intoxication was taken into consideration during the clinical course. Autopsy failed to reveal a macroscopically discernible cause of death. Significant findings on microscopic examination included acute tubular necrosis in the kidneys, pre-existing marked accumulation of neutral lipid within the hepatocytes as well as hyperacute liver damage with evidence of almost complete hepatocyte necrosis. Carbamazepine and levetiracetam were simultaneously determined from blood and tissues such as liver, lungs, muscle and kidneys by LC-MS/MS following addition of lamotrigine as an internal standard and liquid-liquid extraction. Validation data are given for levetiracetam. Both carbamazepine and levetiracetam were present in blood at concentrations within or below the therapeutic range, respectively. Moreover, tissue concentrations suggested long-term administration of anticonvulsant drugs, which is in accordance with the medical history. After excessive drug concentrations could be ruled out, the metabolic consequences of a prolonged carbamazepine therapy to cause severe hepatic injury in the present case are discussed. A mechanism of injury to the hepatocytes may be membrane damage by either an increased production of free radicals and/or a decreased free radical scavenging capacity. Following ischemia with reperfusion and during hyperthermia, large amounts of free radicals are formed. Induction of the mixed oxidase activity during longterm administration of carbamazepine may also increase production of free radicals, leaving the hepatic cell more vulnerable to oxidative injury.     

Serum norharman and harman analysis using high pressure liquid chromatography/mass spectrometry and value of beta-carbolines as blood alcohol markers

Firstly, a method for LC-MS/MS-analysis of the beta-carbolines norharman and harman in serum was established and validated. Secondly, serum samples from persons during ethanol loading conditions were investigated (n = 26). Norharman was regularly found positive only in persons with BAC > 1.6@1000. In this subgroup harman was detected in 5 out of 9 cases. The finding of norharman concentrations > 50 pg/mL in the serum of 4 out of 5 control persons was of high interest. In addition serum samples of smokers (n = 9) were analyzed for the beta-carbolines. All samples from smokers were tested positive for norharman with concentrations > 50 pg/mL in 7 cases. These results were in accordance with recent reports in literature and underline that the beta-carbolines norharman and harman do not meet the criteria of alcohol state-markers and positive serum sample testing may result from endogenous as well as from exogenous sources.